The ReBalance Method – Application Form
Thank you for your interest in The ReBalance Method.This programme is a deeply personalised 6-month journey designed to support the body physically, mentally and emotionally through a structured root cause healing approach.Please take your time answering the questions below openly and honestly. This helps me understand where you are currently at in your health journey and whether this programme is the right fit for you.Once submitted, I will personally review your application and be in touch regarding next steps.
Applicant Details
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Age
*
Location
*
Current Health Situation
What are the main health concerns or symptoms you are currently experiencing?
*
How long have you been experiencing these symptoms?
*
Please Select
Less than 6 months
6–12 months
1–3 years
3–5 years
5+ years
How are these symptoms currently impacting your life?
*
Have you previously worked with any practitioners or tried other approaches to improve your health?
Do you currently take any medications or supplements? If yes, please list medications and what they are for.
How would you currently rate your stress levels?
*
Please Select
Very low
Manageable
Moderate
High
Constantly overwhelmed
How is your sleep currently?
Do you feel you are living in “survival mode” or constantly pushing through exhaustion?
*
Please Select
Yes often
Sometimes
Rarely
No
Support Needs and Readiness
Which areas do you feel need the most support right now?
*
Energy
Digestion
Hormones
Nervous system/stress
Skin
Weight
Sleep
Mood
Immune system
Blood sugar balance
Inflammation
Other
Why do you feel now is the right time to invest in your health?
*
What would improving your health allow you to do, feel, or experience in your life?
*
Are you ready to actively participate in your healing journey over the next 6 months?
*
Please Select
Yes, I believe so
I’m unsure
Are you willing to make supportive changes to your nutrition, lifestyle, and daily habits throughout the programme?
*
Please Select
Yes
Somewhat
Unsure
Have you reviewed the programme investment and are you financially ready to invest in this level of support?
*
Please Select
Yes
I would need a payment plan
I’m unsure
What drew you to The ReBalance Method specifically?
*
Is there anything else you feel is important for me to know?
Submit Application
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